Get the most out of your plan's drug formulary
Check drug coverage, view updates and manage your medication costs
About drug formularies
A formulary is a list of prescription drugs and medications that are covered by your plan. It's continually updated over time. Covered drugs' costs and restrictions vary by plan.
Drugs are selected by GHP and represent medications believed to be a necessary part of a quality treatment program.
Whether you're a Geisinger Health Plan member or still shopping for insurance, you can use the formulary to:
- See if your drug is covered
- Find in-network pharmacies
- See updates and recalls
View the formulary for your plan or the plan type you're interested in.
For customized results, sign into the member portal to view your plan's formulary.
Navigate your plan's formulary
A well-structured formulary improves patient care by helping physicians prescribe safe, effective medications for the best possible outcomes. We generally cover the drugs listed in our formulary if they're prescribed at a network pharmacy and all plan rules are followed.
For details on filling your prescriptions, see your Evidence of Coverage.
Understand drug tiers
Formularies have tiers representing different drug costs:
- Lower tiers usually include generic medications.
- Higher tiers usually include expensive brand-name or specialty drugs for rare conditions.
Factors influencing tier assignment include:
- Whether a generic option is available
- Total cost
- Cost comparison with other drugs that treat the same condition
- Over-the-counter alternatives
- Clinical and economic factors
Options for drugs not in your plan's formulary
Formulary addition request
Doctors can request changes to the formulary through the Geisinger Health Plan Pharmacy Department
- 800-988-4861
- Monday - Friday, 8 a.m. – 5 p.m., ET
- TDD/TTY: 711, Monday - Friday, 8 a.m. – 4:30 p.m., ET
Request a formulary exception
To request coverage for a non-formulary drug:
- Sign into the member portal
- Send a secure message to request an exception
A representative will review your request and contact your physician. Pennsylvania law requires formulary exceptions to be initiated by a physician.
Formulary exclusions
Depending on your plan, some medications may not be covered. These can include:
- Over-the-counter medications
- Experimental or investigational therapies
- Cosmetic drugs
Prescription drug recall
When the FDA issues a Class I or Class II drug recall, Geisinger Health Plan quickly informs members and their prescribing doctors.
If you received the recalled medication through your pharmacy benefits, you'll get a notification.
- Class I: There's a good chance the medication can cause serious health problems or even death.
- Class II: The medication may cause temporary or reversible health issues, and in rare cases, serious health problems.
For the latest info on drug recalls, market withdrawals and safety alerts, visit the FDA website.
Pharmacy coverage updates
Formulary updates
Pharmacy and therapeutics committee notes
Searching for covered drugs and pharmacies
Pharmacy services for all members, call 800-988-4861 (TTY:711) | Monday – Friday, 8 a.m. – 5 p.m.
Sign in for faster results
When you sign in to your member portal account, your plan is preselected.
Explore your member pharmacy benefits
Learn about your benefits and coverage, sign up for mail-order pharmacy and more.
Common Pharmacy Terms
Geisinger Gold Medicare Advantage HMO, PPO, and HMO D-SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company/Geisinger Quality Options, Inc., health plans with a Medicare contract. Continued enrollment in Geisinger Gold depends on contract renewal. Geisinger Health Plan, Geisinger Indemnity Insurance Company, and Geisinger Quality Options, Inc. are part of Geisinger, an integrated health care delivery and coverage organization. Risant Health is the parent organization of Geisinger.
Y0032_24319_5_C